Macular Degeneration

For patients with age-related macular degeneration (AMD), Duke offers state-of-the-art diagnostic, medical, and surgical care, as well as low vision rehabilitation services, orientation and mobility training, and a patient and family support program.

AMD is the leading cause of central vision loss in the Western world in persons over the age of 55.

At Duke, your care team has broad experience and expertise in AMD and includes retina physicians and surgeons, low vision rehabilitation specialists, social workers, and AMD-trained ophthalmic technicians and staff.

Duke Eye Center has been a worldwide leader in AMD care and research for the last several decades. Duke physicians have played a major role in the development of current AMD treatments and continue to be leaders in AMD research and clinical trials.

Therapies Available

Anti-angiogenesis therapy: Several medications limit the growth of new blood vessels or diminish their injury to the retina and may prevent vision loss from wet AMD. These are typically injected in and/or around the eye.

Doctors also use bevacizumab (Avastin), which is off-label, meaning it is not FDA-approved for injection in the eye. There is an ongoing NIH-sponsored clinical trial comparing Lucentis and Avastin. Both Lucentis and Avastin are used widely by retina specialists, and many insurance plans cover these drugs for AMD.

Photodynamic therapy (PDT): Dye is used to make abnormal blood vessels sensitive to light. The dye is injected intravenously and activated by a low-power laser, sometimes called "cold" laser.

Conventional laser therapy: A high-power laser, sometimes called "hot" laser, burns the abnormal blood vessels and overlying retina. This treatment may be used when the abnormal vessels are outside the center of the macula.

Macular translocation surgery: This may be an option if vision continues to worsen despite other treatments such as anti-angiogenesis therapy or photodynamic therapy.

In addition to the therapies listed above, other services offered include:

New patient consultations and referrals
State-of-the-art AMD diagnostics and retinal imaging (Duke is very active in developing retinal imaging technologies. You may undergo standard imaging with fluorescein angiography and optical coherence tomography (OCT). In addition, your doctor may utilize spectral domain OCT, indocyanine green angiography, fundus autofluorescence, or other novel imaging modalities in your retinal evaluation.)
Argon laser photocoagulation
Transpupillary thermotherapy
Submacular surgery
Intravitreal steroids
Access to cutting-edge clinical trials research
Referrals to experts and specialists in other areas of eye disease